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目的应用二维斑点追踪显像技术评价冠心病患者缺血心肌的应变、旋转和扭转,并了解随冠脉病变加重,缺血心肌收缩期各应变及缺血节段扭转角度的变化。方法 31例经冠状动脉造影确诊为冠心病患者,按供血冠脉病变狭窄程度将缺血心肌分为两组,即狭窄<70%缺血心肌组(137节段),狭窄≥70%缺血心肌组(174节段)。正常对照组21例,共357个心肌节段。使用EchaoPAC工作站对其进行应变分析,得到纳入研究668个心肌节段圆周应变、径向应变、纵向应变及旋转角度,并计算相应节段扭转角度。结果冠心病组缺血心肌节段纵向、径向、圆周收缩期峰值应变均值较正常组降低,且差异有统计学意义(纵向应变:-21.06±2.26 vs-17.47±2.92、-14.91±2.91;圆周应变-22.29±3.50 vs-19.72±6.99、-15.75±3.90;径向应变:24.52±9.89 vs 20.95±7.53、15.97±2.61,P均<0.05);冠心病组缺血心肌节段扭转角度均值较正常组降低,且差异有统计学意义(P<0.05)。冠脉病变越重、病变支数越多,狭窄冠脉所支配缺血心肌节段纵向、径向、圆周收缩期峰值应变均值及扭转角度越低。应用ROC曲线计算二维应变参数诊断冠心病缺血心肌节段的AUC以纵向应变最高。在截断值为-17.58%时灵敏度为93%,特异度为52%。结论 2D-STI能准确评价冠心病患者左室局部收缩功能异常;局部心肌纵向应变、圆周应变、径向应变和扭转角度可反映冠脉狭窄严重程度。
Objective To evaluate the changes of strain, rotation and torsion of ischemic myocardium in patients with coronary heart disease by two-dimensional speckle tracking imaging. Methods Thirty-one patients diagnosed as having coronary artery disease by coronary angiography were divided into two groups according to the degree of coronary artery stenosis: ischemic myocardium (<137%), stenosis≥70%, ischemia Myocardial group (174 segments). 21 cases of normal control group, a total of 357 myocardial segments. Strain analysis was performed using EchaoPAC workstation, and circumferential strain, radial strain, longitudinal strain and rotation angle of 668 myocardial segments were included in the study, and the corresponding segment torsion angles were calculated. Results The average peak strain in longitudinal, radial and circumferential systolic phases in coronary heart disease group was lower than that in normal group (longitudinal strain: -21.06 ± 2.26 vs -17.47 ± 2.92, -14.91 ± 2.91; The circumferential strain was -22.29 ± 3.50 vs-19.72 ± 6.99, -15.75 ± 3.90; the radial strain was 24.52 ± 9.89 vs 20.95 ± 7.53 and 15.97 ± 2.61, respectively, P <0.05). In the coronary heart disease group, Compared with the normal group, the difference was statistically significant (P <0.05). Coronary artery disease is more serious, the lesion count more, stenosis coronary artery atherosclerotic myocardial longitudinal, radial, circumferential systolic peak strain mean and torsion angle lower. Application of ROC curve to calculate two-dimensional strain parameters in the diagnosis of coronary heart disease myocardial ischemic segment AUC with the highest vertical strain. Sensitivity of 93% and specificity of 52% at a cutoff of -17.58%. Conclusion 2D-STI can accurately evaluate left ventricular regional systolic dysfunction in patients with coronary heart disease. Local myocardial longitudinal strain, circumferential strain, radial strain and torsion angle can reflect the severity of coronary stenosis.